EP2363096A1 - Band zur Wiederherstellung des Ansatzes an einen Knochen eines Bindegewebes, wie eine Sehne oder ein Band - Google Patents

Band zur Wiederherstellung des Ansatzes an einen Knochen eines Bindegewebes, wie eine Sehne oder ein Band Download PDF

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Publication number
EP2363096A1
EP2363096A1 EP11156634A EP11156634A EP2363096A1 EP 2363096 A1 EP2363096 A1 EP 2363096A1 EP 11156634 A EP11156634 A EP 11156634A EP 11156634 A EP11156634 A EP 11156634A EP 2363096 A1 EP2363096 A1 EP 2363096A1
Authority
EP
European Patent Office
Prior art keywords
bone
soft tissue
longitudinal
band
textile
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Withdrawn
Application number
EP11156634A
Other languages
English (en)
French (fr)
Inventor
Justin C. Anderson
Djamal Rushdy
Kevin L. Ohasi
Ralph Mattern
Dale Peterson
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Tornier Inc
Original Assignee
Tornier Inc
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Tornier Inc filed Critical Tornier Inc
Publication of EP2363096A1 publication Critical patent/EP2363096A1/de
Withdrawn legal-status Critical Current

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/08—Muscles; Tendons; Ligaments
    • A61F2/0811—Fixation devices for tendons or ligaments
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/08—Muscles; Tendons; Ligaments
    • A61F2/0811—Fixation devices for tendons or ligaments
    • A61F2002/0847—Mode of fixation of anchor to tendon or ligament
    • A61F2002/0858—Fixation of tendon or ligament between anchor and bone, e.g. interference screws, wedges

Definitions

  • the present invention relates to a band for restoring the attachment to a bone of a soft tissue, such as a tendon or ligament. It also relates to a corresponding restoration method.
  • JP-A-2002/058 676 proposes to catch a knee ligament in the form of a loop, passing inside a wire element of suspension that it is possible both to close on itself, while adjusting its length, by knotting or by a average reported ad hoc, and attach to a knee bone.
  • This wired suspension element is therefore similar to, in a way, an adjustable extension of tendon repair.
  • the object of the present invention is to provide a band and a method of restoration, which can retain a soft tissue vis-à-vis a bone reliably and perennially.
  • the subject of the invention is a strip for restoring the attachment to a bone of a soft tissue, as defined in claim 1.
  • This strip makes it possible to implement a method of restoring the fastener. to a bone of a soft tissue, such as a tendon or a ligament, in which there is an elongate flexible textile body including, in its longitudinal direction, first and second longitudinal portions, the first longitudinal portion being integral with securing means to the second longitudinal portion, and wherein, after passing at least a portion of the second longitudinal portion at least through the soft tissue and engaging with the bone, as the case may be by passing it through a tunnel made in the bone, the fixing means is mechanically engaged with this second longitudinal portion of in order to maintain the flexible body, which has been subjected to a tensile stress, in the form of a loop encircling a portion of the soft tissue, as well as a part of the bone if necessary, in order to retain the tissue soft vis-à-vis the bone.
  • One of the basic ideas of the invention is to bind the textile band to the soft tissue by conforming the flexible body of this band into a loop threaded through the soft tissue and closed on itself by a fastening means which retains the flexible body under tension.
  • the fastening between the body of the band and the soft tissue is performed essentially, if not exclusively, by this loop arrangement, which encloses a portion of the soft tissue and maintains it vis-à-vis the bone, supporting high tensile stresses and effectively transmitting these stresses to the soft tissue.
  • securing means reported during the surgical operation of implementation of this band, such as sutures, are not necessary.
  • the aforementioned loop may even be advantageously provided for passing through a tunnel made in the bone: in this case, no securing means reported during the surgical procedure, such as screws, is necessary to bind the textile band to the bone, because the latter then encloses part of the bone and effectively transmits tension stresses applied to the band.
  • the fastening means according to the invention making it possible to maintain the loop formed by the flexible body under tension, can take various embodiments, as presented in detail hereinafter, it being understood that these various forms induce variations.
  • implementation for the surgical method of setting up the band In any case, the restoration performance is remarkable.
  • the flexible body of the band according to the invention can be made of various textile materials, in the broad sense of the term, allowing in particular its tissue colonization.
  • the flexible body of the band can advantageously be provided, by means of the material or materials that constitute it and the structure that it presents. as strong and stiff as the soft tissue to restore, if not more.
  • This band 1 mainly comprises an elongated flexible textile body 2.
  • this body 2 is a textile strip, composed in particular of braided son according to two different axes.
  • the threads of this textile strip define three different axes.
  • Each of the threads of the strip is either a monofilament or a multifilament, where appropriate rectilinear or twisted helically around the central axis of the thread.
  • the threads of this textile strip are made either of a resorbable material, in which case examples of materials are hydroxybutyrate, such as Tephaflex (registered trademark), Artelon (trademark) and glycolic-based polymers. or lactic, a non-absorbable material, in which case examples of materials are polyester, nylon, polyetheretherketone (PEEK), silk, polyacetal, polyurethane, polyaramid, etc.
  • the textile body 2 of the band 1 advantageously has a porosity favoring tissue colonization.
  • the textile body 2 is designed to have a high tensile stress, for obvious reasons of mechanical strength and stress resistance, as well as to have a stiffness close to that of the soft tissue to be restored, especially between 0.degree. 2 and 2 times, preferably 0.5 and 1 time, the stiffness of the tissue to be restored: in this way, the tissue colonization of the textile body 2 is favored.
  • the body 2 of the strip 1 consists of two successive longitudinal portions 2A and 2B in the longitudinal direction of the body: in the embodiment considered, the part 2A corresponds to one of the two opposite end zones of the body 2, including the free end of this end zone, which, as explained in detail below, is integrally provided with a rigid or semi-rigid piece.
  • Part 2B corresponds to the remainder of the body 2, that is to say, in the embodiment considered here, to the current zone of the body 2 and the end zone of this body, opposite the portion 2A.
  • the portion 2B of the body 2 has, near each of its longitudinal ends, a consolidation region 2B 1 at which the cross section of the body 2 changes, in particular by crushing on itself the material constituting the body: and between the two consolidation regions 2B 1 in the longitudinal direction of the body 2, the latter has a larger cross section than that on either side of these consolidation regions.
  • This arrangement facilitates the manipulation of the terminal areas of the body 2, as is better understood later, while, in view of its greater cross section, the restoration effect by the current area of the body 2 is reinforced.
  • the part 10 provided at the free end of the part 2A of the body 10 is shown in more detail on the Figures 2 to 4 .
  • This piece 10 is, in the embodiment considered in these figures, in the overall form of a parallelepiped whose largest dimension, which can be described as length, extends in the longitudinal direction of the body 2.
  • the part 10 comprises two opposite end portions 10A and 10B, which are connected to one another by two opposite side walls 10C belonging to the part 10, and which delimit between them, together with the side walls 10C, a through hole 11.
  • the hole 11 extends transversely to the aforementioned longitudinal direction, connecting to each other the two opposite main faces 12 and 13 of the part 10.
  • This blind cavity 14 is dimensioned in a complementary manner to the free end of the body portion 2A, opening on the longitudinal end edge of the part portion 10A, thereby allowing to introduce and accommodate the body portion 2A in the cavity 14.
  • each of these points 15, shaped in the manner of a shark fin has, in the direction of the outlet of the cavity 14, a ramp face, inclined towards the inside of the cavity 14, potentially being slightly convex, while, on the opposite side, the tip 15 defines a shoulder, potentially slightly hollow.
  • this end easily slides against the ramp surface of the tips 15, to cross the top of these tips, in the direction of the bottom of the cavity 14.
  • the subsequent disengagement of the body portion 2A is prevented by the shoulder of the tips 15, which mechanically lock the body portion 2A in a direction opposite to that of introducing the body portion 2A into the cavity 14.
  • the non-return spikes 15 are evenly distributed along the largest dimension of the cross section of the cavity 14, extending, alternately, from one and the other of the two opposite major faces of the cavity 14 .
  • the end portion 10B of the piece 10 has, on its side opposite the end portion 10A, an outer surface 16 curved or, more generally, convex, in particular to limit the traumatic effects of the piece 10 after implantation of the band 1.
  • the end portion 10B is essentially in the form of a cylindrical bar with a circular section, centered on an axis perpendicular to the longitudinal direction of the part 10, the aforementioned curved surface 16 corresponding to a portion of the surface of this cylindrical bar.
  • the portion 17 of the outer surface of this cylindrical bar, diametrically opposed to the curved surface 16, partially delimits the through hole 11, as clearly visible on the figure 3 .
  • the hole 11 is delimited by a flat surface 18 formed by the end portion 10A.
  • the threading hole 11 is internally provided with anti-return spikes 19, clearly visible on the Figures 2 and 3 .
  • these non-return spikes 19 protrude from the surface 17 of the part terminal 10A, being shaped shark fin: on the side directed towards the main face 12 of the part 10, each of these points 19 delimits a ramp surface 19A, preferably curved, while on the opposite main face side 13, the tip 19 defines a shoulder 19B, preferably dug.
  • band 1 will now be described, in particular with regard to figures 5 and 6 , to restore the attachment of soft tissue T to bone B.
  • bone B is a humerus of a human being while soft tissue T is one of the tendons or ligaments belonging to the rotator cuff, associated with the aforementioned humerus.
  • a tunnel B 1 is made through the bone B, in the zone of the latter where it is intended to attach the soft tissue T.
  • this bone tunnel B 1 can be provided bent, so as to open, at each of its two ends, on substantially the same face of the bone B.
  • a forest or similar surgical ancillary is introduced into the face said bone twice, so as to achieve two tunnel parts that meet in the thickness of the bone B.
  • a straight bone tunnel B1 can be realized through the bone B, by the fact that this tunnel then opens on two different sides of the bone B.
  • the essential is that the bone tunnel passes through the bone B in a resistant and stable area thereof.
  • the free end of the part 2B of the body 2 of the band 1 is put inside this tunnel, after having passed this free end of the body part 2B through the tissue
  • the free end of the part of the body. 2B is advantageously provided with an attached needle 3, as shown in FIG. figure 1 , or a similar element.
  • the small cross section of the end zone of the body portion 2B facilitates donning of this body part successively through the soft tissue T and in the bone tunnel B 1 .
  • Threading the free end of the body portion 2B continues in the bone tunnel B 1 , to bring out this free end by the tunnel outlet, another through which the free end has been introduced, as indicated by the bent arrow F 1 on the figure 5 .
  • the free end of the body portion 2B thus emerges from the bone B.
  • This free end is then threaded into the hole 11 of the part 10, thus crossing the latter from its face 12 to its face 13, as shown by the arrow F 2 on the figure 6 .
  • the needle 3 facilitates this threading in the hole 11.
  • the body 2 of the band 1 thus forms a loop, which is closed on itself at the part 10 and inside which are arranged a portion of the soft tissue T and a portion of the bone B, as schematically shown in the figure 5 .
  • the threading of the body portion 2B through the hole 11 continues so as to progressively tighten the aforementioned loop around the soft tissue T and the bone B: the body 2 is thus progressively stretched along its longitudinal direction, embracing the soft tissue T and the bone B. Thanks to the non-return spikes 19, the threading of the body portion 2B is unidirectional so that, as the body 2 is stretched, the loop formed by this body tightens, without loosening possible.
  • the band 1 retains the soft tissue T Tightly vis-à-vis the bone B, firmly and stably. Due to the fact that the band 1 is passed through the soft tissue T and then shaped into a loop enclosing a portion of this soft tissue, the connection between the band 1 and the soft tissue T is durable and withstands high tension stresses, without requiring the addition of additional fixing means between the body 2 and the soft tissue, these stresses being effectively transmitted from the textile body 2 to the soft tissue T. Similarly, thanks to the fact that the band 1 is passed through a portion of the bone B, forming a loop enclosing this bone part, it is firmly bonded to the bone B, without the addition of additional fastening means between the body 2 and the bone.
  • the clasping of the soft tissue T by the textile body 2 promotes the rapid and complete tissue colonization of the latter when it has an ad hoc porosity, it being understood that the textile body 2 is provided to maintain this porosity when is stretched and shaped in a loop. Via this colonization, the transmission of efforts between the body 2 and the soft tissue T is further improved, with a distribution that can change over time, as the soft tissue heals.
  • bands 1 can be used, in a juxtaposed way, to reinforce the restoration of the fastening between the soft tissue T and the bone B.
  • the same band 1 can be used to make two crossed loops, with a sufficient length for the body 2 of this band.
  • the band 1 is provided integrally, replacing the threading part 10, a threading piece 20 whose function is similar to that of the part 10 to restore the attachment of a soft tissue to bone.
  • the threading piece 20 delimits a threading through hole 21, functionally similar to the threading hole 11, and arranged, in the longitudinal direction of the strip 1, between two end portions. 20A and 20B of the part 20.
  • the part 20A of the part 20 has a smaller longitudinal dimension, linked in particular to the fact that the fastening of the part 20 to the body 2 of the strip 1 is made differently than that of the part 10: rather than providing that the free end of the body portion 2A is introduced and retained in a blind cavity similar to the cavity 14, it is contemplated that the free end of the body portion 2A is glued, sewn, intermingled or, more generally, integrally connected by any suitable means to the end portion 20A of the piece 20.
  • the end portion 20B of the piece 20 is in the form of a hoop, that is to say in a different geometric form of the cylindrical bar formed by the end portion 10B of the piece 10
  • the hole 21 of the workpiece 20 is provided with nonreturn points 29, functionally similar to the tips 19 of the workpiece 10, with the difference that the tips 29 project. of the end portion 20A while the tips 19 are provided protruding from the end portion 10B of the piece 10.
  • this illustrates the various possibilities of relative positional arrangement of the non-return points in the threading hole defined by the threading piece.
  • the hole 21 of the part 20 is, in addition to the tips 29, provided with spikes identical to the tips 19.
  • the body 2 of the band 1 is integrally provided, instead of the threading part 10 or the threading piece 20, a engaging piece 30 defining a threading hole 31 delimited between the end portions 30A and 30B of the part 30, functionally similar to the hole 21 and to the parts 20A and 20B of the part 20.
  • the part 30 differs from the part 20 by replacing the nonreturn points 29 by a tongue 39, which is protrudes from the end portion 30A and the opposite free end is provided to bear resiliently against the hoop that constitutes the end portion 30B.
  • this tongue 39 deviates from the end portion 30B during threading of the portion 2B of the body 2, in particular by flexible deformation of its connection zone to the end portion 30A, in the manner of a hinge, while, once the loop formed by the body 2 is tightened with the desired intensity, the free end of the tongue 39 blocks the body portion 2B against the end portion 30B, by jamming effect.
  • the free end of the portion 2A of the body 2 is, instead of the threading parts 10, 20 or 30, provided with a threading piece 40 in the form of a ring delimiting internally a threading hole 41 functionally similar to the threading hole 11, 21 or 31.
  • the ring of the part 40 is associated with a second ring 49 structurally similar to the ring of the part 40.
  • the function of this ring 49 is to mechanically block the part 2B of the body 2 after the latter has been threaded into the hole 41 and the loop formed by the body 2 has been tightened with the desired intensity, and this by jamming.
  • a possible procedure is to pass the body portion 2B through both the threading piece 40 and the ring 49, and then reintroduce it through the workpiece 40, bypassing the outside the ring 49.
  • FIG 11 To the figure 11 is shown another variant of a part 50 provided integral with the free end of the portion 2A of the body 2 and adapted to attach, by attachment, to the portion 2B of the body 2 after the latter has been passed through the soft tissue T and in a tunnel made through the bone B.
  • This attachment piece 50 is provided with hooks 59 adapted to anchor, by penetration, into the material constituting the part 2B of the body 2 and thus fix the part body 2A so that the body 2 forms a tight loop with a desired intensity. It will be understood that the hooks 59 hold firmly a mechanical engagement with the body portion 2B as long as the body 2 is subjected to a longitudinal tensioning force.
  • a band 100 intended to restore the attachment of a soft tissue T, such as a tendon or a ligament, to a bone B.
  • This band 100 comprises an elongate flexible body 102 which is structurally and functionally similar to the body 2 of the band 1.
  • the band 100 is distinguished from the band 1 by the embodiment of its means for fixing to each other separate longitudinal portions 102A and 102B of the body 102, so that the body 102 forms a closed loop on it -even. More specifically, the body portion 102A delimits, in its current portion, a slot 110 sized to allow the body portion 2B to be inserted therein, by first introducing the free end of this body portion 2B, then tightening the loop then formed by the body 102.
  • the slot 110 may have an extremely simple shape, consisting of a longitudinal cut of the material constituting the part of the body 2A.
  • the edge of this slot 110 may be reinforced by a rigid or semi-rigid piece forming an eyelet.
  • this eyelet is internally provided with one or more mechanical locking elements, functionally or even structurally similar to the nonreturn points 19 or 29 or the tongue 39 described above.
  • the slot 110 makes it possible to fix the body part 2A the body portion 2B threaded into this slot 110, to keep the body 2 thus shaped and in a loop.
  • the band 100 can be used in the same way as the band 1, as described above.
  • Figures 13 and 14 illustrate another possibility of using the band 100, which is moreover applicable to the band 1: rather than passing the body part 102B through both the soft tissue T and the bone B, this body portion 102B is passed only through the soft tissue T, preferably with a needle 103 similar to the needle 3 for the band 1, and then, after having threaded this body portion 102B through the slot 110 of the body portion 102A and tighten the loop thus formed by the body 102 with the desired intensity, the body portion 102B is connected to the bone B by an attached integral member 104, such as a screw or, more generally, a bone anchor, as shown on the figure 14 .
  • an attached integral member 104 such as a screw or, more generally, a bone anchor

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  • Health & Medical Sciences (AREA)
  • Orthopedic Medicine & Surgery (AREA)
  • Rehabilitation Therapy (AREA)
  • Rheumatology (AREA)
  • Cardiology (AREA)
  • Oral & Maxillofacial Surgery (AREA)
  • Transplantation (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Vascular Medicine (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Prostheses (AREA)
  • Surgical Instruments (AREA)
EP11156634A 2010-03-02 2011-03-02 Band zur Wiederherstellung des Ansatzes an einen Knochen eines Bindegewebes, wie eine Sehne oder ein Band Withdrawn EP2363096A1 (de)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
US30979910P 2010-03-02 2010-03-02
FR1053601A FR2959658B1 (fr) 2010-05-07 2010-05-07 Bande de restauration de l'attache a un os d'un tissu mou tel qu'un tendon ou un ligament

Publications (1)

Publication Number Publication Date
EP2363096A1 true EP2363096A1 (de) 2011-09-07

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Family Applications (1)

Application Number Title Priority Date Filing Date
EP11156634A Withdrawn EP2363096A1 (de) 2010-03-02 2011-03-02 Band zur Wiederherstellung des Ansatzes an einen Knochen eines Bindegewebes, wie eine Sehne oder ein Band

Country Status (3)

Country Link
US (1) US20120059468A1 (de)
EP (1) EP2363096A1 (de)
FR (1) FR2959658B1 (de)

Cited By (2)

* Cited by examiner, † Cited by third party
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EP2567673A1 (de) * 2011-09-12 2013-03-13 Tornier, Inc. Reinforcing band for restoring soft tissue
ITMO20120217A1 (it) * 2012-09-17 2014-03-18 Ncs Lab S R L Dispositivo per il fissaggio di tendini muscolari ad un osso.

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FR2959658A1 (fr) 2011-11-11
FR2959658B1 (fr) 2013-07-26

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